Aims: We report the maternal and foetal outcomes at birth and after 6 months in a cohort of pregnant women with hypertrophic cardiomyopathy (HCM). Although most women with HCM tolerate pregnancy well, there is an increased risk of obstetric and cardiovascular complications. Methods and results: All pregnant women with HCM entered into the prospective worldwide Registry of Pregnancy and Cardiac disease (ROPAC) were included in this analysis. The primary endpoint was a major adverse cardiovascular event (MACE), which included death, heart failure (HF), thrombo-embolic event, and arrhythmia...

The ABC of paediatric ECG interpretation In paediatric patients, ECG is used as a tool for investigation of arrhythmias, chest pain, syncope, intoxications and congenital heart abnormalities. Paediatric ECGs differ significantly from adult ECGs, and change gradually during childhood, largely because of the changes that start with the transition of foetal circulation at birth. This evolution is most prominent during the first year of life, but it is not until the late adolescent years that the ECG corresponds to that of adults...

This case series was done at Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, to observe safety and efficacy of manual vacuum aspiration and frequency of complications in cardiac patients with missed abortion. All cardiac patients presenting in first trimester with diagnosed early foetal demise (missed miscarriage) or incomplete miscarriage were included. Manual vacuum aspiration was done as an outpatient procedure. Cardiac and procedure related complications including arrhythmias, thromboembolism, heart failure and ischaemia were noted...

BACKGROUND: Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS: Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed...

BACKGROUND: Prenatal screening for foetal cardiac abnormalities has been increasingly practiced in Sweden during the last 25 years. A prenatal diagnosis may have medical benefits but may also cause sustained parental psychological distress. The aim of this study was to explore pregnant women's, and their partner's, experiences of counselling and need for support during continued pregnancy following a prenatal diagnosis of a cardiac defect. A second aim was to use this information to propose a structured follow-up programme for continued support after the first counselling...

The update course in foetal cardiology held by the Fetal Working Group of the Association for European Paediatric and Congenital Cardiology in Istanbul in May 2012 included a session on foetal cardiac therapy. In the introductory overview to this symposium, we critically examine the level of evidence supporting or refuting proposed foetal cardiac therapies including transplacental treatment of foetal tachyarrhythmias, steroid treatment in foetal atrioventricular block, and foetal aortic valvuloplasty. In summary, the evidence for the efficiency and safety of currently available foetal cardiac therapies is low, with no therapy based on a randomised controlled trial...

Foetal echocardiography has become an established subspecialty in paediatric cardiology. The skills to perform detailed assessment of foetal cardiac anomalies in a tiny, moving foetus surrounded by sometimes challenging layers of maternal tissue are not easy to obtain, and require prolonged periods of specific training and supervised scanning in expert centres. The goal of this overview is to discuss the importance of the awareness of the fact that expert examination of the foetal heart and in-depth knowledge of newborn surgical interventions are only a part of the picture; many cardiac abnormal foetuses do not just have an isolated cardiac defect...

Accurate foetal electrocardiogram (FECG) morphology extraction from non-invasive sensors remains an open problem. This is partly due to the paucity of available public databases. Even when gold standard information (i.e derived from the scalp electrode) is present, the collection of FECG can be problematic, particularly during stressful or clinically important events.In order to address this problem we have introduced an FECG simulator based on earlier work on foetal and adult ECG modelling. The open source foetal ECG synthetic simulator, fecgsyn, is able to generate maternal-foetal ECG mixtures with realistic amplitudes, morphology, beat-to-beat variability, heart rate changes and noise...

Despite significant advances in adult clinical electrocardiography (ECG) signal processing techniques and the power of digital processors, the analysis of non-invasive foetal ECG (NI-FECG) is still in its infancy. The Physionet/Computing in Cardiology Challenge 2013 addresses some of these limitations by making a set of FECG data publicly available to the scientific community for evaluation of signal processing techniques.The abdominal ECG signals were first preprocessed with a band-pass filter in order to remove higher frequencies and baseline wander...

: CMACE 2008 has shown that the overall rate of mortality from cardiac disease has tripled over the last two decades being, the largest cause of indirect maternal death; mainly due to acquired heart disease. With the current increase in older mothers, obesity, immigration and survival of babies operated on for congenital heart disease, the need to identify women at risk of heart disease and to plan their careful management is crucial. Early identification of risk factors include hypertension, pre-eclampsia, diabetes, smoking, obesity and hyperlipidaemia and a multidisciplinary management improves maternal and foetal outcomes...

OBJECTIVES: The aim of this study was to determine the timing of neonatal cardiac intervention in babies with antenatally diagnosed congenital heart disease and the impact on obstetric management. METHODS: A retrospective review of all deliveries between January, 2008 and December, 2009 was conducted in a tertiary centre with foetal and paediatric cardiology, maternal-foetal medicine, and obstetric units. All live births with antenatally detected congenital heart disease were included...

AIMS: To describe the outcome of pregnancy in patients with structural or ischaemic heart disease. METHODS AND RESULTS: In 2007, the European Registry on Pregnancy and Heart disease was initiated by the European Society of Cardiology. Consecutive patients with valvular heart disease, congenital heart disease, ischaemic heart disease (IHD), or cardiomyopathy (CMP) presenting with pregnancy were enrolled. Data for the normal population were derived from the literature...

Although the survival rate for preterm subjects has improved considerably, due to the progress in the field of perinatal medicine, preterm birth is frequently the cause underlying a series of notorious complications: morphological, neurological, ophthalmological, and renal alterations. In addition, it has recently been demonstrated how low gestational age and reduced foetal growth contribute towards an increased cardiovascular risk in preterm neonates. In fact, cardiovascular mortality is higher among former preterm adults than those born at term...

BACKGROUND: Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa. METHODS: We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period. RESULTS: Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on...

Thanks to embryological knowledge, morphological anatomy and segmental analysis, paediatric cardiology is today an exact science. Modern diagnostically and therapeutical approach in paediatric cardiology allows early application of foetal echocardiography in order of achieving diagnosis of congenital heart anomalies in utero. Diagnostic modalities in paediatric cardiology are represented the application of transthoracic echocardiography, transoesophageal, 3D and in recent years 4D echocardiography with possibilities of heart imaging via magnetic resonance and computerised tomography...

OBJECTIVE: To assess the possibility of foetal circulatory system evaluation between 11+0 to 13+6 weeks of gestation in a reference perinatal cardiology centre. MATERIAL AND METHODS: A prospective study was conducted between January 2004 and June 2008 in patients admitted to the reference perinatal cardiology centre for a foetal echocardiographic examination. 1170 foetuses were examined: 31 in 2004, 167 in 2005, 310 in 2006, 406 in 2007 and 262 in the first half of 2008...

AIM: To determine cardiac outcomes of foetal hydrops as a result of twin-twin transfusion syndrome treated with laser surgery. METHODS: Hydrops identified in 16 recipient foetuses with twin-twin transfusion syndrome was treated with laser ablation surgery to anastomotic vessels. Prior to laser surgery, the foetuses were assessed by echocardiography for cardiac abnormalities and ventricular and valvular dysfunction. After delivery, echocardiography was performed on 15 of the 16 newborn infants...

Turner's syndrome is characterized by an ovarian failure, which occurs in most cases before puberty and leads to infertility. In vitro fertilization with oocyte donation has dramatically transformed the prognosis of infertility of these women. However, in the same time, it has become obvious that pregnancies in Turner's syndrome are at very high risk of possible sudden death because of a specific risk for cardiovascular complications involving aortic root dissection. We report the case of a serious cardiac failure occurred during a twin pregnancy obtained by oocyte donation in a 39-year-old patient with Turner's syndrome...

BACKGROUND: Few data are available on the evolution in the number of referrals and the spectrum and frequency of issues addressed in paediatric cardiac outpatient clinics. AIM: To assess the volume and range of symptoms and diagnoses in patients, referred to a paediatric cardiac outpatient clinic in an academic hospital setting. METHODS: Data were collected prospectively over 6 months. RESULTS: Historical comparison showed that the number of outpatient visits increased from 819 during the first semester of 2004 to 865, 1045 and 1391 during the first semesters of 2005, 2006 and 2007, respectively...